Volmink J, Lancaster T, Gray S, Silagy C
Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, UK.
Fam Pract. 1996 Feb;13(1):84-91. doi: 10.1093/fampra/13.1.84.
A number of different therapies have been used for postherpetic neuralgia. We decided to conduct a systematic review of existing randomized controlled trials.
To determine the efficacy of available therapies for relieving the pain of established postherpetic neuralgia.
We performed a systematic review, including meta-analysis, of existing randomized controlled trials. Eleven published trials and one unpublished trial were identified which met the inclusion criteria and were included in the current review.
Pooled analysis of the effect of tricyclic antidepressants demonstrate statistically significant pain relief (OR 0.15, CI 0.08-0.27). Pooling of the results of the three trials comparing the effects of capsaicin and placebo could not be done due to heterogeneity. This heterogeneity was mainly attributable to an unpublished trial which differed in terms of the dose and duration of treatment. When this study was omitted, no heterogeneity was found and the pooled analysis revealed a statistically significant benefit (OR 0.29, 95% CI 0.16-0.54). However, problems with blinding in patients using capsaicin may have accounted for the positive effect. One small study of vincristine iontophoresis compared to placebo also yielded a favourable result (OR 0.05, 95% CI 0.01-0.26). Other treatment evaluated include lorazepam, acyclovir, topical benzydamine, and acupuncture. We found no evidence that these are effective in relieving pain associated with postherpetic neuralgia.
Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia.
多种不同的疗法已用于治疗带状疱疹后神经痛。我们决定对现有的随机对照试验进行系统评价。
确定现有疗法缓解已确诊的带状疱疹后神经痛疼痛的疗效。
我们对现有的随机对照试验进行了系统评价，包括荟萃分析。确定了11项已发表的试验和1项未发表的试验，这些试验符合纳入标准并被纳入当前评价。
三环类抗抑郁药疗效的汇总分析显示疼痛缓解具有统计学意义（OR 0.15，CI 0.08 - 0.27）。由于异质性，无法对比较辣椒素和安慰剂效果的三项试验结果进行汇总。这种异质性主要归因于一项未发表的试验，该试验在治疗剂量和持续时间方面存在差异。当省略该研究时，未发现异质性，汇总分析显示具有统计学意义的益处（OR 0.29，95% CI 0.16 - 0.54）。然而，使用辣椒素的患者中存在的盲法问题可能解释了这种积极效果。一项将长春新碱离子导入疗法与安慰剂进行比较的小型研究也得出了有利结果（OR 0.05，95% CI 0.01 - 0.26）。评估的其他治疗方法包括劳拉西泮、阿昔洛韦、外用苄达明和针灸。我们没有发现证据表明这些方法对缓解带状疱疹后神经痛相关疼痛有效。
基于随机试验的证据，三环类抗抑郁药似乎是已确诊的带状疱疹后神经痛唯一经证实有益的药物。
